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Previous Volume 346:982-987 March 28, 2002 Number 13 Next

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ABSTRACT

Background The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks.

Methods We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks.

Results Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks.

Conclusions There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

We conducted a study to determine the prevalence of psychopathologic disorders in Manhattan after September 11 and to identify predictors of these conditions. We focused on post-traumatic stress disorder (PTSD) and depression, the two most commonly studied psychological sequelae of trauma and disasters.^3,4,5

Methods

Data Collection and Sample

Data were collected through telephone interviews with a random sample of Manhattan residents between October 16 and November 15, 2001. The institutional review board of the New York Academy of Medicine approved the study, and oral informed consent was obtained from the study subjects.

The sampling frame consisted of adults living in households with telephones in Manhattan. We restricted the sample to households south of 110th Street, a demographically homogeneous area and the part of Manhattan that is closest to the World Trade Center (Figure 1). Using random-digit dialing, we screened households for geographic eligibility, and an adult in each household was randomly selected to be interviewed (whoever had the most recent birthday was selected). We made up to 10 attempts to contact an adult at each number. The overall cooperation rate for the survey was 64.3 percent.

View larger version (47K): [in this window] [in a new window]   Figure 1. Sampling Frame in Relation to the Site of the World Trade Center. The sampling frame includes the area between 110th Street and Canal Street (yellow), and the area south of Canal Street (orange).

 
Study Instruments

Respondents were asked questions from a structured questionnaire in English or Spanish. We asked questions about demographic characteristics, where the respondent was living before September 11, and the respondent's location during the attacks. For the analyses, total social support was categorized as low, medium, or high. We asked about three aspects of social support — emotional (i.e., "someone to love you and make you feel wanted"), instrumental (i.e., "someone to help you if you were confined to bed"), and appraisal (i.e., "someone to give you good advice in a crisis") — in the six months before September 11.⁶ We also asked whether the respondent had experienced any of eight stressful events (e.g., the death of a spouse) in the previous year.

Respondents were asked whether they had directly witnessed the attacks, had feared they would die during the attacks, had friends or relatives who were killed during the attacks, had been displaced from home, had been involved in the rescue effort, or had lost a job or possessions because of the attacks. Documentation of a panic attack was based on a modified version of the National Institute of Mental Health Diagnostic Interview Schedule; the diagnosis required the development of at least four characteristic symptoms during or soon after the attacks.

PTSD was assessed with the use of the PTSD questionnaire from the National Women's Study, which is a modified version of the Diagnostic Interview Schedule for PTSD. For the diagnosis of current PTSD, this instrument has a coefficient of 0.71 for agreement with clinician-administered structured clinical interviews, and it uses a non–event-specific approach to the assessment of PTSD symptoms.⁵ Current PTSD was defined as the presence of at least one recurrent symptom (e.g., intrusive memories or distressing dreams), three avoidance symptoms (e.g., efforts to avoid thoughts associated with the trauma or loss of interest in activities associated with it), and two symptoms of hyperarousal (e.g., difficulty falling asleep or concentrating). All symptoms must have persisted for 2 weeks or longer and must have been present within the previous 30 days to qualify as symptoms of current PTSD. In addition, for symptoms that involved specific content (e.g., memories or thoughts), we asked about the content; these symptoms had to be related to the September 11 attacks to qualify as symptoms of current PTSD. We used a modified, validated version of the Structured Clinical Interview in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, for a major depressive episode to determine the presence of depression within the previous 30 days.⁷

Statistical Analysis

We calculated both the overall prevalences of current PTSD and depression and the prevalences according to covariates of interest. Two-tailed chi-square tests were used to identify associations between covariates and either PTSD or depression. Multiple logistic regression was used to examine predictors separately for PTSD and depression. Covariates were considered in a multivariate regression model in which bivariate chi-square P values were less than 0.1. Differences in log likelihood (P<0.05) were used to determine whether variables would be retained in subsequent models. We tested for interactions between key predictor variables in the final models. Analyses were weighted to compensate for potential bias due to the number of adults in a household and the number of telephones. We used SUDAAN software to adjust all analyses for weighting.⁸

Results

Sample

Of the 1008 adults surveyed, 20 were excluded from the analysis because of missing weight variables (i.e., the number of adults or the number of telephones in the household). Overall, 52.0 percent of the respondents were women, and 71.6 percent were white; the mean (±SD) age was 42±15 years. Age, sex, race or ethnic group, and residence distributions in our sample were similar to estimates obtained from the 2000 U.S. Census for our sampling frame.⁹ On September 11, 5.2 percent of the respondents lived south of Canal Street.

Prevalence of PTSD and Depression

The prevalence of PTSD was 7.5 percent (95 percent confidence interval, 5.7 to 9.3 percent), and the prevalence of depression was 9.7 percent (95 percent confidence interval, 7.3 to 11.3 percent). Overall, 13.6 percent of the respondents reported symptoms that met the criteria for either PTSD or depression, and 3.7 percent reported symptoms that met the criteria for both disorders.

Bivariate Analyses

Table 1 shows the results of bivariate analyses. The covariates associated with whether the respondent had PTSD were sex (P=0.005), residence before the attacks (P=0.04), level of social support (P=0.01), number of stressors in the 12 months before September 11 (P<0.001), whether the respondent witnessed the events (P=0.01), whether the respondent had a panic attack during or soon after the events (P<0.001), whether possessions were lost (P=0.01), whether the respondent was involved in the rescue effort (P=0.03), and whether the respondent lost a job because of the attacks (P=0.005).

View this table: [in this window] [in a new window]   Table 1. Bivariate Associations between Characteristics of the Respondents and Current Post-Traumatic Stress Disorder (PTSD) or Depression.

 
Covariates associated with whether the respondent had depression were sex (P=0.03), race or ethnic group (P=0.03), yearly household income (P=0.006), level of education (P=0.007), level of social support (P<0.001), number of stressors in the 12 months before September 11 (P<0.001), whether the respondent had a panic attack during or soon after the events (P<0.001), whether a friend or relative died during the attacks (P=0.04), and whether the respondent lost a job because of the attacks (P=0.006).

Multivariate Analyses

In a multivariate logistic-regression model (Table 2), significant predictors of PTSD were Hispanic ethnicity as compared with white race (odds ratio, 2.6), two or more stressors in the 12 months before September 11 as compared with none (odds ratio, 5.5), a panic attack (odds ratio, 7.6), residence south of Canal Street before the attacks (odds ratio, 2.9), and loss of possessions due to the attacks (odds ratio, 5.6). The significant predictors of depression were Hispanic ethnicity (odds ratio, 3.2), two or more stressors in the 12 months before September 11 (odds ratio, 3.4), a panic attack (odds ratio, 2.6), a low as compared with a high level of social support (odds ratio, 2.4), the death of a friend or relative in the attacks (odds ratio, 2.3), and loss of a job because of the attacks (odds ratio, 2.8).

View this table: [in this window] [in a new window]   Table 2. Multivariate Associations between Characteristics of the Respondents and Current Post-Traumatic Stress Disorder (PTSD) or Depression.

 
Discussion

In our survey of a representative sample of adults living south of 110th Street in Manhattan, conducted five to eight weeks after the September 11 attacks, 7.5 percent of the respondents reported symptoms consistent with the diagnosis of current PTSD, and 9.7 percent reported symptoms consistent with the diagnosis of current depression. These prevalences suggest that in the area below 110th Street approximately 67,000 persons had PTSD and approximately 87,000 had depression during the time of the study.⁹ Although the estimated prevalences of current psychopathology vary according to the population studied, in a benchmark national study, the prevalence of PTSD within the previous year was 3.6 percent,¹⁰ and the prevalence of depression within the previous 30 days was 4.9 percent,¹¹ suggesting that the prevalences in our survey were approximately twice the base-line values.

The prevalence of psychological sequelae of disasters has been documented in only a few community-based samples, and comparison of the findings is limited by differences in sampling frames and the interval between the event and the assessment. Using outcome measures that were similar to ours, Hanson et al. reported that the overall prevalence of PTSD was 4.1 percent six months after the 1992 civil disturbances in Los Angeles County.¹² The prevalence of depression in our study is similar to that reported after floods (9.5 percent).¹³

Persons directly affected by disasters have higher rates of post-event psychiatric disorders than persons indirectly affected.^14,15 Our survey showed that the prevalence of PTSD was higher among the persons who were most directly exposed to the attacks or their consequences (e.g., those living south of Canal Street, the area closest to the attacks, and those who lost possessions) than among persons with less direct exposure. Factors associated with grief (e.g., loss of a family member) increased the likelihood of depression, a finding that is consistent with the results of previous studies.^16,17

We found bivariate associations between female sex and both PTSD and depression, a finding that is consistent with the results of most studies.^3,16,18 However, our adjusted models suggested that other factors may have been important mediators of the association between sex and psychopathology after this disaster. For example, the level of social support may have influenced the association between sex and depression.

Hispanic ethnicity was associated with both PTSD and depression, and the association was independent of other covariates. Although the relation between membership in a minority group and psychopathology after a disaster has been suggested in previous studies,¹⁹ few have specifically examined the role of Hispanic ethnicity.²⁰ Research with veterans of the Vietnam War has shown that Hispanics may have a higher prevalence of PTSD than persons of other racial or ethnic backgrounds.²¹ Sociocultural influences have been proposed as mediators of this relation.²²

We also found a relation between a low level of social support and both PTSD and depression in bivariate analyses and between a low level of social support and depression in adjusted analyses. Social ties have a positive role in mental health.²³ After a disaster, a low level of social support has been shown to be related to PTSD and depressive symptoms.^24,25

Our study provides strong evidence of an association between initial panic symptoms and subsequent psychopathology. Although the prognostic role of panic symptoms in determining the risk of PTSD or depression cannot be determined from a cross-sectional survey, this finding is consistent with previous research documenting associations between initial emotional responses to trauma and the development of PTSD.^26,27 These findings suggest that interventions addressing such initial reactions to a disaster may help prevent the development of long-lasting psychological sequelae.²⁸

Prospective evaluations of PTSD in trauma victims and in the general population suggest that the symptoms of PTSD decrease substantially within three months after a traumatic experience²⁹ but that up to a third of cases of PTSD may not fully remit.^3,30 How long the psychological sequelae of the September 11 attacks will last remains to be seen, and it is possible that the prevalence of symptoms in our study reflects transient stress reactions to some degree. However, the ongoing threat of terrorist attacks may affect both the severity and the duration of these psychological symptoms.³¹ More than 100,000 persons in New York City may lose their jobs as a result of the September 11 attacks,³² and the cleanup efforts and disruption of services throughout the city will continue for a long time. In this context, the high prevalence of psychopathology that we documented among the residents of Manhattan is not surprising. Future research in New York City should determine the prognostic role of the factors that were associated with PTSD and depression in our study.

Supported by grants from the United Way of New York City, the New York Community Trust, and the National Institute on Drug Abuse (R01 DA14219-01S1).

We are indebted to Mr. Mark Morgan for invaluable contributions to the conduct of this study; to Dr. Joseph Boscarino for ongoing feedback; to Dr. Donald Hoover for statistical assistance; to Dr. Neal Cohen, Commissioner of Health for the New York City Department of Health, and Mr. Len McNally of the New York Community Trust, for their encouragement; to the interviewers at Schulman, Ronca, and Bucuvalas; and to all the persons who participated in the study during a difficult time for New Yorkers.

Source Information

From the Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York (S.G., J.A., J.G., D.V.); the Department of Epidemiology, Columbia University Mailman School of Public Health, New York (S.G., D.V.); the National Crime Victims' Research and Treatment Center, Medical University of South Carolina, Charleston (H.R., D.K.); Schulman, Ronca, and Bucuvalas, New York (M.B.); and Bellevue Hospital Center, New York (J.G.).

Address reprint requests to Dr. Galea at the Center for Urban Epidemiologic Studies, Rm. 556, New York Academy of Medicine, 1216 Fifth Ave., New York, NY 10029-5283, or at sgalea{at}nyam.org.

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• WHALLEY, M. G., BREWIN, C. R. (2007). Mental health following terrorist attacks. Br. J. Psychiatry 190: 94-96 [Abstract] [Full Text]  
• Druss, B. G., Henderson, K. L., Rosenheck, R. A. (2007). Swept Away: Use of General Medical and Mental Health Services Among Veterans Displaced By Hurricane Katrina. Am. J. Psychiatry 164: 154-156 [Abstract] [Full Text]  
• Feldner, M. T., Monson, C. M., Friedman, M. J. (2007). A Critical Analysis of Approaches to Targeted PTSD Prevention: Current Status and Theoretically Derived Future Directions. Behav Modif 31: 80-116 [Abstract]  
• DiMaggio, C., Galea, S., Madrid, P. (2006). SSRI Prescription Rates After a Terrorist Attack. Psychiatr. Serv. 57: 1656-1657 [Full Text]  
• Covell, N. H., Donahue, S. A., Allen, G., Foster, M. J., Felton, C. J., Essock, S. M. (2006). Use of Project Liberty Counseling Services Over Time by Individuals in Various Risk Categories. Psychiatr. Serv. 57: 1268-1270 [Abstract] [Full Text]  
• Jackson, C. T., Allen, G., Essock, S. M., Foster, M. J., Lanzara, C. B., Felton, C. J., Donahue, S. A. (2006). Clusters of Event Reactions Among Recipients of Project Liberty Mental Health Counseling. Psychiatr. Serv. 57: 1271-1276 [Abstract] [Full Text]  
• Jackson, C. T., Covell, N. H., Shear, K. M., Zhu, C., Donahue, S. A., Essock, S. M., Felton, C. J. (2006). The Road Back: Predictors of Regaining Preattack Functioning Among Project Liberty Clients. Psychiatr. Serv. 57: 1283-1290 [Abstract] [Full Text]  
• Shear, K. M., Jackson, C. T., Essock, S. M., Donahue, S. A., Felton, C. J. (2006). Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001. Psychiatr. Serv. 57: 1291-1297 [Abstract] [Full Text]  
• Donahue, S. A., Jackson, C. T., Shear, K. M., Felton, C. J., Essock, S. M. (2006). Outcomes of Enhanced Counseling Services Provided to Adults Through Project Liberty. Psychiatr. Serv. 57: 1298-1303 [Abstract] [Full Text]  
• Gomes, C., McGuire, T. G., Foster, M. J., Donahue, S. A., Felton, C. J., Essock, S. M. (2006). Did Project Liberty Displace Community-Based Medicaid Services in New York?. Psychiatr. Serv. 57: 1309-1312 [Abstract] [Full Text]  
• Covell, N. H., Essock, S. M., Felton, C. J., Donahue, S. A. (2006). Characteristics of Project Liberty Clients That Predicted Referrals to Intensive Mental Health Services. Psychiatr. Serv. 57: 1313-1315 [Abstract] [Full Text]  
• Jackson, C. T., Allen, G., Essock, S. M., Felton, C. J., Donahue, S. A. (2006). Clients' Satisfaction With Project Liberty Counseling Services. Psychiatr. Serv. 57: 1316-1319 [Abstract] [Full Text]  
• Covell, N. H., Donahue, S. A., Ulaszek, W. R., Dunakin, L., Essock, S. M., Felton, C. J. (2006). Effectiveness of Two Methods of Obtaining Feedback on Mental Health Services Provided to Anonymous Recipients. Psychiatr. Serv. 57: 1324-1327 [Abstract] [Full Text]  
• Ahern, J., Galea, S. (2006). Social context and depression after a disaster: the role of income inequality.. J. Epidemiol. Community Health 60: 766-770 [Abstract] [Full Text]  
• Violanti, J. M., Castellano, C., O'Rourke, J., Paton, D. (2006). Proximity to the 9/11 Terrorist Attack and Suicide Ideation in Police Officers. Traumatology 12: 248-254 [Abstract]  
• Levav, I., Novikov, I., Grinshpoon, A., Rosenblum, J., Ponizovsky, A. (2006). Health Services Utilization in Jerusalem Under Terrorism. Am. J. Psychiatry 163: 1355-1361 [Abstract] [Full Text]  
• Ai, A. L., Evans-Campbell, T., Santangelo, L. K., Cascio, T. (2006). The Traumatic Impact of the September 11, 2001, Terrorist Attacks and the Potential Protection of Optimism. J Interpers Violence 21: 689-700 [Abstract]  
• Wu, P., Duarte, C. S., Mandell, D. J., Fan, B., Liu, X., Fuller, C. J., Musa, G., Cohen, M., Cohen, P., Hoven, C. W. (2006). Exposure to the World Trade Center Attack and the Use of Cigarettes and Alcohol Among New York City Public High-School Students. AJPH 96: 804-807 [Abstract] [Full Text]  
• Shalev, A. Y., Tuval, R., Frenkiel-Fishman, S., Hadar, H., Eth, S. (2006). Psychological Responses to Continuous Terror: A Study of Two Communities in Israel. Am. J. Psychiatry 163: 667-673 [Abstract] [Full Text]  
• Fraley, R. C., Fazzari, D. A., Bonanno, G. A., Dekel, S. (2006). Attachment and Psychological Adaptation in High Exposure Survivors of the September 11th Attack on the World Trade Center. Pers Soc Psychol Bull 32: 538-551 [Abstract]  
• Des Jarlais, D. C., Galea, S., Tracy, M., Tross, S., Vlahov, D. (2006). Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS. AJPH 96: 561-567 [Abstract] [Full Text]  
• Grieger, T. A., Waldrep, D. A., Lovasz, M. M., Ursano, R. J. (2005). Follow-Up of Pentagon Employees Two Years After the Terrorist Attack of September 11, 2001. Psychiatr. Serv. 56: 1374-1378 [Abstract] [Full Text]  
• Detsky, M. E., Sivilotti, M. L. A., Kopp, A., Austin, P. C., Juurlink, D. N. (2005). Deliberate Self-Poisoning in Ontario Following the Terrorist Attacks of September 11, 2001. JAMA 294: 1900-1901 [Full Text]  
• Vlahov, D., Galea, S. (2005). Invited Commentary: Considering Bias in the Assessment of Respiratory Symptoms among Residents of Lower Manhattan following the Events of September 11, 2001. Am J Epidemiol 162: 508-510 [Full Text]  
• Hagan, J. F. Jr, and the Committee on Psychosocial Aspects of Child, , and the Task Force on Terrorism, (2005). Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician. Pediatrics 116: 787-795 [Abstract] [Full Text]  
• Galea, S., Nandi, A., Vlahov, D. (2005). The Epidemiology of Post-Traumatic Stress Disorder after Disasters. Epidemiol Rev 27: 78-91 [Full Text]  
• Rodriguez-Carballeira, A., Javaloy, F. (2005). Psychosocial Analysis of the Collective Processes in the United States After September 11. Conflict Management and Peace Science 22: 201-216 [Abstract]  
• Shalev, A. Y., Freedman, S. (2005). PTSD Following Terrorist Attacks: A Prospective Evaluation. Am. J. Psychiatry 162: 1188-1191 [Abstract] [Full Text]  
• Ai, A. L., Cascio, T., Santangelo, L. K., Evans-Campbell, T. (2005). Hope, Meaning, and Growth Following the September 11, 2001, Terrorist Attacks. J Interpers Violence 20: 523-548 [Abstract]  
• Hoven, C. W., Duarte, C. S., Lucas, C. P., Wu, P., Mandell, D. J., Goodwin, R. D., Cohen, M., Balaban, V., Woodruff, B. A., Bin, F., Musa, G. J., Mei, L., Cantor, P. A., Aber, J. L., Cohen, P., Susser, E. (2005). Psychopathology Among New York City Public School Children 6 Months After September 11. Arch Gen Psychiatry 62: 545-551 [Abstract] [Full Text]  
• Catalano, R., Bruckner, T., Gould, J., Eskenazi, B., Anderson, E. (2005). Sex ratios in California following the terrorist attacks of September 11, 2001. Hum Reprod 20: 1221-1227 [Abstract] [Full Text]  
• Azoulay, E., Pochard, F., Kentish-Barnes, N., Chevret, S., Aboab, J., Adrie, C., Annane, D., Bleichner, G., Bollaert, P. E., Darmon, M., Fassier, T., Galliot, R., Garrouste-Orgeas, M., Goulenok, C., Goldgran-Toledano, D., Hayon, J., Jourdain, M., Kaidomar, M., Laplace, C., Larche, J., Liotier, J., Papazian, L., Poisson, C., Reignier, J., Saidi, F., Schlemmer, B. (2005). Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients. Am. J. Respir. Crit. Care Med. 171: 987-994 [Abstract] [Full Text]  
• Reisinger, Y., Mavondo, F. (2005). Travel Anxiety and Intentions to Travel Internationally: Implications of Travel Risk Perception. Journal of Travel Research 43: 212-225 [Abstract]  
• Njenga, F. G., Nicholls, P. J., Nyamai, C., Kigamwa, P., Davidson, J. R. T. (2004). Post-traumatic stress after terrorist attack: psychological reactions following the US embassy bombing in Nairobi: Naturalistic study. Br. J. Psychiatry 185: 328-333 [Abstract] [Full Text]  
• Adams, M. L., Ford, J. D., Dailey, W. F. (2004). Predictors of Help Seeking Among Connecticut Adults After September 11, 2001. AJPH 94: 1596-1602 [Abstract] [Full Text]  
• Cabaniss, D. L., Forand, N., Roose, S. P. (2004). Conducting Analysis After September 11: Implications for Psychoanalytic Technique. J Am Psychoanal Assoc 52: 717-734 [Abstract]  
• Druss, B. G., Marcus, S. C. (2004). Use of Psychotropic Medications Before and After Sept. 11, 2001. Am. J. Psychiatry 161: 1377-1383 [Abstract] [Full Text]  
• Verger, P., Dab, W., Lamping, D. L., Loze, J.-Y., Deschaseaux-Voinet, C., Abenhaim, L., Rouillon, F. (2004). The Psychological Impact of Terrorism: An Epidemiologic Study of Posttraumatic Stress Disorder and Associated Factors in Victims of the 1995-1996 Bombings in France. Am. J. Psychiatry 161: 1384-1389 [Abstract] [Full Text]  
• Melamed, S., Shirom, A., Toker, S., Berliner, S., Shapira, I. (2004). Association of Fear of Terror With Low-Grade Inflammation Among Apparently Healthy Employed Adults. Psychosom. Med. 66: 484-491 [Abstract] [Full Text]  
• Schoenfeld, F. B., Marmar, C. R., Neylan, T. C. (2004). Current Concepts in Pharmacotherapy for Posttraumatic Stress Disorder. Psychiatr. Serv. 55: 519-531 [Abstract] [Full Text]  
• Laraque, D., Boscarino, J. A., Battista, A., Fleischman, A., Casalino, M., Hu, Y.-Y., Ramos, S., Adams, R. E., Schmidt, J., Chemtob, C. (2004). Reactions and Needs of Tristate-Area Pediatricians After the Events of September 11th: Implications for Children's Mental Health Services. Pediatrics 113: 1357-1366 [Abstract] [Full Text]  
• Fairbrother, G., Stuber, J., Galea, S., Pfefferbaum, B., Fleischman, A. R. (2004). Unmet Need for Counseling Services by Children in New York City After the September 11th Attacks on the World Trade Center: Implications for Pediatricians. Pediatrics 113: 1367-1374 [Abstract] [Full Text]  
• Siegel, C. E., Laska, E., Meisner, M. (2004). Estimating Capacity Requirements for Mental Health Services After a Disaster Has Occurred: A Call for New Data. AJPH 94: 582-585 [Abstract] [Full Text]  
• Torabi, M. R., Seo, D.-C. (2004). National Study of Behavioral and Life Changes Since September 11. Health Educ Behav 31: 179-192 [Abstract]  
• Wayment, H. A. (2004). It Could Have Been Me: Vicarious Victims and Disaster-Focused Distress. Pers Soc Psychol Bull 30: 515-528 [Abstract]  
• Boscarino, J. A., Galea, S., Adams, R. E., Ahern, J., Resnick, H., Vlahov, D. (2004). Mental Health Service and Medication Use in New York City After the September 11, 2001, Terrorist Attack. Psychiatr. Serv. 55: 274-283 [Abstract] [Full Text]  
• Catalano, R. A., Kessell, E. R., McConnell, W., Pirkle, E. (2004). Psychiatric Emergencies After the Terrorist Attacks of September 11, 2001. Psychiatr. Serv. 55: 163-166 [Abstract] [Full Text]  
• Vlahov, D., Galea, S., Ahern, J., Resnick, H., Kilpatrick, D. (2004). Sustained Increased Consumption of Cigarettes, Alcohol, and Marijuana Among Manhattan Residents After September 11, 2001. AJPH 94: 253-254 [Abstract] [Full Text]  
• Weissman, E. M., Kushner, M., Marcus, S. M., Davis, D. F. (2003). Volume of VA Patients With Posttraumatic Stress Disorder in the New York Metropolitan Area After September 11. Psychiatr. Serv. 54: 1641-1643 [Abstract] [Full Text]  
• Fagan, J., Galea, S., Ahern, J., Bonner, S., Vlahov, D. (2003). Relationship of Self-Reported Asthma Severity and Urgent Health Care Utilization to Psychological Sequelae of the September 11, 2001 Terrorist Attacks on the World Trade Center Among New York City Area Residents. Psychosom. Med. 65: 993-996 [Abstract] [Full Text]  
• Grieger, T. A., Fullerton, C. S., Ursano, R. J. (2003). Posttraumatic Stress Disorder, Alcohol Use, and Perceived Safety After the Terrorist Attack on the Pentagon. Psychiatr. Serv. 54: 1380-1382 [Abstract] [Full Text]  
• Grieger, T. A., Fullerton, C. S., Ursano, R. J., Reeves, J. J. (2003). Acute Stress Disorder, Alcohol Use, and Perception of Safety Among Hospital Staff After the Sniper Attacks. Psychiatr. Serv. 54: 1383-1387 [Abstract] [Full Text]  
• Rudenstine, S., Galea, S., Ahern, J., Felton, C., Vlahov, D. (2003). Awareness and Perceptions of a Communitywide Mental Health Program in New York City After September 11. Psychiatr. Serv. 54: 1404-1406 [Abstract] [Full Text]  
• Galea, S., Vlahov, D., Resnick, H., Ahern, J., Susser, E., Gold, J., Bucuvalas, M., Kilpatrick, D. (2003). Trends of Probable Post-Traumatic Stress Disorder in New York City after the September 11 Terrorist Attacks. Am J Epidemiol 158: 514-524 [Abstract] [Full Text]  
• Mansdorf, I. J., Weinberg, J. (2003). Stress reactions in Israel in the face of terrorism: Two Community Samples. Traumatology 9: 155-168 [Abstract]  
• Bleich, A., Gelkopf, M., Solomon, Z. (2003). Exposure to Terrorism, Stress-Related Mental Health Symptoms, and Coping Behaviors Among a Nationally Representative Sample in Israel. JAMA 290: 612-620 [Abstract] [Full Text]  
• Saylor, C. F., Cowart, B. L., Lipovsky, J. A., Jackson, C., Finch, A. J. Jr. (2003). Media Exposure to September 11: Elementary School Students' Experiences and Posttraumatic Symptoms. American Behavioral Scientist 46: 1622-1642 [Abstract]  
• Ford, C. A., Udry, J. R., Gleiter, K., Chantala, K. (2003). Reactions of Young Adults to September 11, 2001. Arch Pediatr Adolesc Med 157: 572-578 [Abstract] [Full Text]  
• Rosenblum, A., Joseph, H., Fong, C., Kipnis, S., Cleland, C., Portenoy, R. K. (2003). Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities. JAMA 289: 2370-2378 [Abstract] [Full Text]  
• DeLisi, L. E., Maurizio, A., Yost, M., Papparozzi, C. F., Fulchino, C., Katz, C. L., Altesman, J., Biel, M., Lee, J., Stevens, P. (2003). A Survey of New Yorkers After the Sept. 11, 2001, Terrorist Attacks. Am. J. Psychiatry 160: 780-783 [Abstract] [Full Text]  
• Klitzman, S., Freudenberg, N. (2003). Implications of the World Trade Center Attack for the Public Health and Health Care Infrastructures. AJPH 93: 400-406 [Abstract] [Full Text]  
• Breslau, N., Davis, G. C., Schultz, L. R. (2003). Posttraumatic Stress Disorder and the Incidence of Nicotine, Alcohol, and Other Drug Disorders in Persons Who Have Experienced Trauma. Arch Gen Psychiatry 60: 289-294 [Abstract] [Full Text]  
• Pantin, H. M., Schwartz, S. J., Prado, G., Feaster, D. J., Szapocznik, J. (2003). Posttraumatic Stress Disorder Symptoms in Hispanic Immigrants After the September 11th Attacks: Severity and Relationship to Previous Traumatic Exposure. Hispanic Journal of Behavioral Sciences 25: 56-72 [Abstract]